Endoscopic Ultrasonography Miniature Probe Performance for Depth Diagnosis of Early Gastric Cancer with Suspected Submucosal Invasion
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Background/Aims: The accurate assessment of the depth of invasion of early gastric cancer (EGC) is critical to determine the most appropriate treatment option. However, it is difficult to distinguish shallow submucosal (SM1) invasion from deeper submucosal (SM2) invasion. We investigated the diagnostic performance of endoscopic ultrasonography (EUS) using a miniature probe for EGC with suspected SM invasion. Methods: From April 2008 to June 2018, EGCs with suspected SM invasion were analyzed retrospectively. The EGCs examined by a 20 MHz high-frequency miniature probe was included in our study. Esophago-gastric junction cancers and patients treated by chemotherapy before resection were excluded. The sensitivity and specificity for the detection of SM2 invasion by EUS were compared with those of white light imaging (WLI). Additionally, factors related to depth underestimation or overestimation were investigated using multivariate analysis. Results: A total of 278 EGCs in 259 patients were included in the final analysis. The sensitivity and specificity for SM2 or deeper by EUS were 73.7% (87/118) and 74.4% (119/160), respectively. The sensitivity and specificity by WLI were 47.5% (56/118) and 68.1% (109/160), respectively. The sensitivity of EUS was significantly superior to that of conventional endoscopy (p<0.01). Multivariate analysis revealed that an anterior location of the EGC was an independent risk factor for underestimation by EUS (odds ratio, 3.3; 95% confidence interval, 1.1 to 9.8; p=0.03). Conclusions: The depth diagnostic performance for EGCs with suspected SM invasion using EUS was satisfactory and superior to that of conventional endoscopy. Additionally, it is important to recognize factors that may lead to misdiagnosis in those lesions.
Abstract
Background/Aims: The accurate assessment of the depth of invasion of early gastric cancer (EGC) is critical to determine the most appropriate treatment option. However, it is difficult to distinguish shallow submucosal (SM1) invasion from deeper submucosal (SM2) invasion. We investigated the diagnostic performance of endoscopic ultrasonography (EUS) using a miniature probe for EGC with suspected SM invasion. Methods: From April 2008 to June 2018, EGCs with suspected SM invasion were analyzed retrospectively. The EGCs examined by a 20 MHz high-frequency miniature probe was included in our study. Esophago-gastric junction cancers and patients treated by chemotherapy before resection were excluded. The sensitivity and specificity for the detection of SM2 invasion by EUS were compared with those of white light imaging (WLI). Additionally, factors related to depth underestimation or overestimation were investigated using multivariate analysis. Results: A total of 278 EGCs in 259 patients were included in the final analysis. The sensitivity and specificity for SM2 or deeper by EUS were 73.7% (87/118) and 74.4% (119/160), respectively. The sensitivity and specificity by WLI were 47.5% (56/118) and 68.1% (109/160), respectively. The sensitivity of EUS was significantly superior to that of conventional endoscopy (p<0.01). Multivariate analysis revealed that an anterior location of the EGC was an independent risk factor for underestimation by EUS (odds ratio, 3.3; 95% confidence interval, 1.1 to 9.8; p=0.03). Conclusions: The depth diagnostic performance for EGCs with suspected SM invasion using EUS was satisfactory and superior to that of conventional endoscopy. Additionally, it is important to recognize factors that may lead to misdiagnosis in those lesions.
참고문헌 (25)
- Japanese Gastric Cancer Association, "Japanese gastric cancer treatment guidelines 2014 (ver. 4)", Gastric Cancer, 20, pp.1~19 (2017)
- Hasuike N, "A non-randomized confirmatory trial of an expanded indication for endoscopic submucosal dissection for intestinal-type gastric cancer(cT1a) : the Japan Clinical Oncology Group study(JCOG0607)", Gastric Cancer, 21, pp.114~123 (2018)
- Cheng J, "Model to identify early-stage gastric cancers with deep invasion of submucosa based on endoscopy and endoscopic ultrasonography findings", Surg Endosc, 32, pp.855~863 (2018)
- Park JS, "Accuracy of endoscopic ultrasonography for diagnosing ulcerative early gastric cancers", Medicine(Baltimore), 95, pp.e3955~ (2016)
- Pei Q, "Endoscopic ultrasonography for staging depth of invasion in early gastric cancer : a meta-analysis", J Gastroenterol Hepatol, 30, pp.1566~1573 (2015)
- Mouri R, "Usefulness of endoscopic ultrasonography in determining the depth of invasion and indication for endoscopic treatment of early gastric cancer", J Clin Gastroenterol, 43, pp.318~322 (2009)
- Mocellin S, "Diagnostic accuracy of endoscopic ultrasonography(EUS)for the preoperative locoregional staging of primary gastric cancer", Cochrane Database Syst Rev, (2), pp.CD009944~ (2015)
- Abe S, "Depth-predicting score for differentiated early gastric cancer", Gastric Cancer, 14, pp.35~40 (2011)
- Choi J, "Endoscopic prediction of tumor invasion depth in early gastric cancer", Gastrointest Endosc, 73, pp.917~927 (2011)
- Kim GH, "Accuracy of high-frequency catheter-based endoscopic ultrasonography according to the indications for endoscopic treatment of early gastric cancer", J Gastroenterol Hepatol, 25, pp.506~511 (2010)
- Kida M, "Staging of gastric cancer with endoscopic ultrasonography and endoscopic mucosal resection", Endoscopy, 30(Suppl 1), pp.A64~A68 (1998)
- Yanai H, "Endoscopic ultrasonography and endoscopy for staging depth of invasion in early gastric cancer : a pilot study", Gastrointest Endosc, 46, pp.212~216 (1997)
- Yoshinaga S, "Endoscopic ultrasound using ultrasound probes for the diagnosis of early esophageal and gastric cancers", World J Gastrointest Endosc, 4, pp.218~226 (2012)
- Kim SJ, "Factors associated with the efficacy of miniprobe endoscopic ultrasonography after conventional endoscopy for the prediction of invasion depth of early gastric cancer", Scand J Gastroenterol, 52, pp.864~869 (2017)
- Watari J, "What types of early gastric cancer are indicated for endoscopic ultrasonography staging of invasion depth?", World J Gastrointest Endosc, 8, pp.558~567 (2016)
- Razavi SM, "Accuracy of endoscopic ultrasonography for determination of tumor invasion depth in gastric cancer", Asian Pac J Cancer Prev, 16, pp.3141~3145 (2015)
- Kim TY, "Morphologic pattern analysis of submucosal deformities identified by endoscopic ultrasonography for predicting the depth of invasion in early gastric cancer", Surg Endosc, 33, pp.2169~2180 (2019)
- Lee HH, "Low accuracy of endoscopic ultrasonography for detailed T staging in gastric cancer", World J Surg Oncol, 10, pp.190~ (2012)
- Okada K, "Endoscopic ultrasonography is valuable for identifying early gastric cancers meeting expandedindication criteria for endoscopic submucosal dissection", Surg Endosc, 25, pp.841~848 (2011)
- Kim J, "Clinical efficacy of endoscopic ultrasonography for decision of treatment strategy of gastric cancer", Surg Endosc, 32, pp.3789~3797 (2018)
- Ikoma N, "Preoperative accuracy of gastric cancer staging in patient selection for preoperative therapy : race may affect accuracy of endoscopic ultrasonography", J Gastrointest Oncol, 8, pp.1009~1017 (2017)
- Yamamoto S, "Evaluation of endoscopic ultrasound image quality is necessary in endosonographic assessment of early gastric cancer invasion depth", Gastroenterol Res Pract, 2012, pp.194530~ (2012)
- Mandai K, "Accuracy of endoscopic ultrasonography for determining the treatment method for early gastric cancer", Gastroenterol Res Pract, 2012, pp.245390~ (2012)
- Tsuzuki T, "Usefulness and problems of endoscopic ultrasonography in prediction of the depth of tumor invasion in early gastric cancer", Acta Med Okayama, 65, pp.105~112 (2011)
- Ji Min Park, "Efficacy of Endoscopic Ultrasonography for Prediction of Tumor Depth in Gastric Cancer", Journal of Gastric Cancer, 11(2), pp.109~115 (2011), 대한위암학회